Incidence and treatment of diplopia after three-wall orbital decompression in Graves' ophthalmopathy.

Abstract

To describe our experience treating diplopia after orbital decompression in patients with thyroid orbitopathy. From May 1997 to July 2001, we performed orbital decompression on 102 patients (34 men and 68 women) with severe proptosis. In 10 (9.8%) of these patients who had no diplopia preoperatively, diplopia in primary gaze occurred after decompression. In 19 (18.6%) of the patients with diplopia in primary gaze before surgery, there was no modification of diplopia after decompression. In 24 (23.5%) of the patients with diplopia in primary gaze before surgery, a more severe imbalance occurred after decompression. Forty-four (83%) of these 53 patients underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. In 9 (17%) of the patients, diplopia was resolved with the use of prismatic lenses. In 31 (70.4%) of 44 patients, we obtained a stable resolution of diplopia in primary position (minimum follow-up, 6 months). In 10 (22.7%) of these patients, a second surgery on the oblique muscles was necessary 6 months after the first surgery to resolve torsional diplopia. In 3 (6.8%) of the patients, diplopia has been resolved with prismatic lenses. Orbital decompression reduces proptosis, but may cause diplopia or worsen it.